Organization
RENAISSANCE RANCH BLUFFDALE MEN'S PROGRAM
Active
Parent organization
AWAKENING BEHAVIORAL HEALTH
Organization subpart
Yes
Provider details
NPI number
Legal business name
AWAKENING BEHAVIORAL HEALTH
Authorized official
WENDY PATTON LSUDC (ADMINISTATIVE DIRECTOR)
(801) 856-7836
Entity
Organization
Contact information
Practice address
2973 W 13800 S, BLUFFDALE, UT 84065-8202
(801) 545-0406
Mailing address
2973 W 13800 S, BLUFFDALE, UT 84065-8202
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
26065
UT
324500000X
Substance Abuse Rehabilitation Facility
Primary
26066
UT
Other
Enumeration date
01/20/2017
Last updated
02/02/2017
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